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Feeding during acute diarrhea as a risk factor for persistent diarrhea.

Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community-based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (> 14 days' duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p < 0.02 Kaplan-Meier log-rank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non-maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.

Acute Disease↗

Detection of neonatal calf diarrhea virus, infant reovirus-like diarrhea virus, and a coronavirus using the fluorescent virus precipitin test.

Thirty-four calf and five infant fecal specimens were tested for the neonatal calf diarrhea virus (NCDV) and for the reovirus-like infantile diarrhea agent; respectively. The procedures used were the fluorescent virus precipitin test and immune electron microscopy. Fourteen of the calf stools contained detectable NCDV, and four of the five infant stools contained the reovirus-like human agent. Infectious NCDV was detected in four of the 34 calf fecal specimens when Madin-Darby bovine kidney cell cultures that had been inoculated with supernatant fluids from stool suspensions were stained with fluorescent antibody. The 20 calf stools that did not have detectable virus were examined for the bovine corona diarrhea virus. Coronavirus was found in two of these specimens.

Animals↗

Induction of mucosal disease in cattle persistently infected with noncytopathic bovine viral diarrhea-mucosal disease virus by superinfection with cytopathic bovine viral diarrhea-mucosal disease virus.

Three head of cattle persistently infected with noncytopathic bovine viral diarrhea-mucosal disease virus (ncBVD-MDV) were superinfected naturally or experimentally with cytopathic bovine viral diarrhea-mucosal disease virus (cBVD-MDV). In the naturally superinfected case, one animal manifested pyrexia and severe diarrhea, and died without developing antibodies to cBVD-MDV. However, another animal survived with only continual slight anorexia and pyrexia, and developed strong resistance to the superinfected strain. In the experimental cases, induction of MD was unsuccessful in two persistently infected cattle when superinfected with cBVD-MDV antigenically heterologous for persistently infected ncBVD-MDV. They also developed antibodies to the cBVD-MDV strain with which they had been infected. After 6 months, these cattle were infected again with a cBVD-MDV strain different from that used in the previous experiment. One animal infected with this strain, which was antigenically homologous to the persistently infected strain, died after developing MD symptoms without developing antibodies to the infecting strain. It is suggested that the antigenic relationship between the persistent ncBVD-MDV and the superinfected cBVD-MDV was an important factor in developing MD.

Animals↗

Efficacy of bovine viral diarrhea vaccine used in Japan against bovine viral diarrhea virus type 2 strain 890.

Bovine viral diarrhea virus (BVDV) has been segregated into two genotypes, type 1 and type 2. To determine the efficacy of the commercially available bovine viral diarrhea type 1 vaccine used in Japan against BVDV type 2, calves were infected with BVDV type 2 strain 890 4 weeks after administration of the vaccine. The vaccinated calves did not develop any clinical signs and hematological changes such as observed in unvaccinated calves after the challenge. Furthermore, the challenge virus was not recovered from the vaccinated calves throughout the duration of the experiment, whereas it was recovered from all unvaccinated calves. The bovine viral diarrhea vaccine used in Japan is efficacious against infection with BVDV type 2 strain 890.

Animals↗

Studies on mechanisms of diarrhea induced by fusarenon-X, a trichothecene mycotoxin from Fusarium species: fusarenon-X-induced diarrhea is not mediated by cyclic nucleotides.

Cardinal signs of red mold toxicosis in man and farm animals are vomiting, nausea, diarrhea, and food refusal. The red mold toxicosis has been suggested to be induced by trichothecenes, which are produced by Fusarium fungi. Fusarenon-X (F-X) is one of the trichothecene mycotoxins. The ip injection of F-X to rats causes an expansion of the small intestine and watery diarrhea. In this study, we measured the concentrations of protein, sodium, potassium, and calcium in the serum of rat treated with F-X for the sake of demonstrating the loss of serum protein and the decreases of serum sodium and calcium by F-X. Since it is well known that some diarrheal diseases are due to the increase of cyclic nucleotide level in the intestinal mucosa, we also measured cyclic AMP and cyclic GMP levels in the intestinal mucosa. It was demonstrated that F-X did not increase the cyclic AMP and cyclic GMP levels in the jejunal and the ileal mucosa at 8 and 24 hr after F-X treatment. The results obtained in this work suggest that F-X-induced diarrhea is not mediated by the cyclic nucleotide system.

Animals↗

Congenital Na+ diarrhea: a new type of secretory diarrhea.

We report a new type of congenital "secretory diarrhea" in a 9-year-old girl that led to contraction and severe metabolic acidosis in the first weeks of life. Her fecal Na+ concentration was high and the pH alkaline. All known causes of secretory diarrhea were excluded. Our findings indicate a defect in the handling of Na+ and H+ in the distal ileum and colon. Treatment with orally administered Na-K-citrate supplementation has normalized her fluid and electrolyte status and allowed normal growth and psychomotor development, but the diarrhea has persisted.

Acidosis↗

Interrelationship between diarrhea and vitamin A deficiency: is vitamin A deficiency a risk factor for diarrhea?

A cross-sectional study, a follow-up study and an evaluation of impact of community-based distribution of vitamin A capsules (200,000 IU) were conducted in Omdurman (Sudan) between November, 1988, and March, 1989. In the cross-sectional survey 1441 children less than 5 years of age participated, which established the baseline values for plasma retinol-binding protein. During the follow-up period 290 cases of diarrhea occurred. Low concentrations of plasma retinol-binding protein (less than 1.85 mg/dl) proved to be a risk factor for diarrhea, especially in girls. The relative risk increased after the second year of life. Children who received vitamin A supplementation before commencement of the study had a lower incidence of diarrhea. The protective effect of vitamin A supplementation was greater in girls (relative risk, 0.297; 95% confidence interval, 0.240 to 0.368) than in boys (relative risk, 0.404; 95% confidence interval, 0.352 to 0.464).

Child, Preschool↗

Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control study.

The role of common diarrheal pathogens in dehydration was examined in children with acute watery diarrhea who attended the treatment center of the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. Two hundred sixty-nine children with moderate or severe dehydration were matched with 700 children with no dehydration. Vibrio cholerae O1 infections were 5.5 times more likely to be associated with dehydration than in cases without this agent. No significant association could be found between the presence of enterotoxigenic Escherichia coli. Campylobacter jejuni, or rotavirus infection and dehydration. These results were obtained after simultaneously controlling for age, lack of oral rehydration therapy (ORT) at home, protein energy malnutrition, withdrawal of breast-feeding during diarrhea at home, poor housing, longer duration of diarrhea at home, and delay in reaching the treatment center. The cholera isolation rate was only 4.5% and thus explains only a small proportion of the cases of dehydration. In cholera-endemic areas, a strategy to prevent dehydration in small children is needed to ensure correct use of ORT at home, prompt referral, and the use of a suitable antibiotic when cholera is clinically suspected.

Acute Disease↗

Symposium on diarrhea. 3. Investigation of chronic diarrhea.

The practical approach to the investigation of diarrhea must be logical and based on anatomic considerations. The site of the underlying disorder may be determined by the clinical picture, and the logic of investigation will be influenced by the history. Important specific investigation in a case of colonic diarrhea include a careful rectal examination, stool inspection, sigmoidoscopy, rectal biopsy and barium enema study. Colonoscopy has been used, but its role has yet to be defined. In a case of small-bowel steatorrhea or diarrhea quantitative chemical estimation of the daily output of stool fat is useful, and to this investigation is added a small-bowel radiograph series and, if the radiographic findings are abnormal, small-bowel biopsy. Other investigations for small-bowel disease may include the breath test with carbon-14-labelled glycocholic acid, the lactose tolerance test, duodenal aspiration for giardiasis, analysis of serum immunoglobulins and, on occasion, isolation of vasoactive intestinal polypeptide hormone (which may aid the diagnosis of functioning tumours of the pancreas or small bowel). Investigations for pancreatic steatorrhea include abdominal radiography, performance of the secretin test and testing of the response to pancreatic replacement therapy. In some patients it may be useful to use endoscopic retrograde cholangiopancreatography to differentiate pancreatic carcinoma and chronic pancreatitis.

Biopsy, Needle↗

[A new etiology of traveler's diarrhea in children: Cryptosporidium diarrhea].

Cryptosporidiosis is a frequent cause of Traveler's diarrhea in children. In its acute or chronic form, this diarrhea is often accompanied by dehydration and accompanying deterioration in health. Diagnosis may be reached by inspection of the stools, for parasites, utilising specific but simple procedures. The latter tests should be carried out by the laboratory in addition to the routine parasitological examination. Prognosis is good in immunocompetent children since the clinical signs spontaneously regress within about a month. The only treatment consists in symptomatic treatment of diarrhea. Spiramycin, though not constantly effective, is reserved for immunosuppressed patients.

Child↗

[Severe protracted diarrhea in infancy ("intractable diarrhea")].

In most cases, protracted diarrhea in infants is due to lack of human breast milk, and iatrogenic malnutrition. Damage to the mucosa of the small intestine maintained by cow's milk proteins and malnutrition constitute main parts of a vicious circle interrupted by completely parenteral nutrition for some time, and slow reintroduction of human breast milk. This kind of therapy reduced mortality significantly. The best prophylaxis is the full support of breast feeding. As differential diagnosis the familial lethal diarrhea of the breast fed infant has to be considered. Furthermore, in case of diarrhea lasting for longer than two weeks, other less frequent causes have to be thought of, as pointed out briefly.

Child, Preschool↗

[Efficacy of poria-polyporus anti-diarrhea oral liquor in treating infantile rotavirus diarrhea: a controlled study with smicta].

The efficacy of Poria-Polyporus Anti-diarrhea Mixture (PPAM) in infantile rotavirus diarrhea with Smicta was observed. In two groups of patients, altogether 60 patients were enrolled. The effective rate in the PPAM group and Smicta groups were 83.33% and 90.00% (P < 0.05) respectively. No statistically significance in respect of the duration of fever and diarrhea. Human rotavirus RNA in stool was detected by PAGE, which showed positive result in 13 patients of PPAM group and 19 in Smicta group. The duration of virus excretion in both group were 2-7 days, which was much shorter than 9-21 days of previous report.

Child, Preschool↗

Symposium on diarrhea. 1. Definition and mechanisms of diarrhea.

Diarrhea, an increase in frequency of evacuation and in water content of the stool, is the result of three categories of mechanism--solute malabsorption, secretion of fluid and motility disturbance. Before diarrhea is considered an abnormal condition, any alteration in stool frequency and content must be related to an individual person's normal bowel habit and to norms for the population, but more than three bowel movements or the passage of liquid stools exceeding 300 g daily should, in general, be considered abnormal. A useful way of understanding the mechanism of diarrhea is to become familiar with the normal functions of the bowel in regard to water and electrolyte absorption and motility, and then to relate these functions to solute malabsorption, fluid secretion and motility disturbance.

Diarrhea↗

Symposium on diarrhea. 5. Postoperative diarrhea.

Under normal circumstances many physiologic mechanisms prevent diarrhea. The most important are the normal processes of gastric emptying, digestion and absorption, the functioning of the ileocecal valve and elimination of bacteria from the small bowel. A surgical procedure may disrupt any of these mechanisms or may unmask a previously asymptomatic disorder that now requires appropriate treatment. Treatment of diarrhea related to surgery may be directed toward the diarrhea itself with such agents as tranquilizers and opiates but if these are not soon effective any disrupted functions must be analysed and specific measures taken to correct or compensate for these disruptions. The most useful measures in appropriate cases are the prevention of the dumping syndrome and the administration of pancreatic enzymes, cholestyramine, hydrophilic stool thickeners and broad-spectrum antibiotics. These measures may be ineffective or inadequate and surgical revision may be necessary.

Diarrhea↗

Diagnosis of natural exposure to bovine viral diarrhea in a vaccinated herd by measuring extended antibody titers against bovine viral diarrhea virus.

Two abortions occurred in a 150-head commercial cow-calf herd. Bovine viral diarrhea was suspected and confirmed by measuring extended titers against bovine viral diarrhea virus (BVDV) in a sample of 15 breeding females. Fifteen were sero-positive and 11 had significantly high titers (1:972-1:8748), likely due to natural exposure to cattle persistently infected with BVDV.

Aborted Fetus↗

Lactulose-mannitol intestinal permeability test in children with diarrhea caused by rotavirus and cryptosporidium. Diarrhea Working Group, Peru.

BACKGROUND: The relationship between intestinal permeability and acute secretory diarrheal syndromes caused by rotavirus and Cryptosporidium parvum in infants less than 36 months of age was studied using the lactulose-mannitol excretion assay. METHODS: An oral solution containing 0.4 g/kg lactulose and 0.1 g/kg mannitol was administered to 15 infants with rotavirus, 7 with Cryptosporidium infection and a control group of 7 with secretory diarrhea admitted to the Oral Rehydration Unit of the National Children's Hospital in Lima, Peru. Urinary sugar excretion was measured using an enzymatic spectrophotometric method. The ratio of urinary excretion of lactulose to mannitol was used to measure intestinal mucosal permeability, with higher ratios indicative of increased intestinal permeability. Infants in all three groups were retested 20 days after the initial test. RESULTS: The (mean +/- SE) lactulose:mannitol (L:M) excretion ratios during the acute phase (day 1) of diarrhea in infants with rotavirus or Cryptosporidium and control infants were 0.67 +/- 0.1, 0.76 +/- 0.16, and 0.26 +/- 0.04, respectively. In the convalescent phase (day 20) the ratios were 0.19 +/- 0.02, 0.28 +/- 0.05, and 0.29 +/- 0.07, respectively. Significant reductions in L:M ratios were noted in rotavirus patients between days 1 and 20 (paired t-test; P < 0.01), Cryptosporidium patients between days 1 and 20 (paired t-test; P < 0.05), and between control subjects on day 1 and rotavirus patients on day 1 and Cryptosporidium patients on day 1 (unpaired t-tests; P < 0.05 for both). There were no significant differences in control subjects between days 1 and 20, control subjects and rotavirus patients on day 20, or control subjects and Cryptosporidium patients on day 20. CONCLUSIONS: The results indicate that increased intestinal permeability caused by rotavirus or cryptosporidium infections in Peruvian infants less than 36 months of age is a significant but reversible phenomenon. The temporal relationship observed in the current study and the contribution of such alterations in intestinal mucosal integrity to the burden of diarrheal disease and the development of malnutrition in developing countries is discussed.

Animals↗

The cultural definition of an infantile diarrhea in Tambon Korat and Koongyang, northeast Thailand: community perceptions in diarrhea control.

In Tambon Korat and Koongyang in Northeastern Thailand, 88% (n = 60) of the mothers and significant other careproviders interviewed believe in poh, a mild, self-limiting diarrhea in infants which is considered a normal prerequisite in child development. The local definition of poh as to its nature, symptomatology and home management and implications for diarrhea control activities are presented in this paper.

Adult↗

Neonatal diarrhea in a diarrhea treatment center in Bangladesh: clinical presentation, breastfeeding management and outcome.

OBJECTIVE: To study the clinical presentation and outcome of neonates admitted with diarrhea, and effect of counseling their mothers for exclusive breastfeeding. DESIGN: Prospective study. SETTING: Inpatient unit. RESULTS: Two hundred and forty-four neonates were studied during 1994-95. Their mean (SD) age was 18 (6.2) days, and body weight and length were 2.18 (0.52) kg and 47.5 (3.2) cm, respectively. More neonates had some dehydration than severe dehydration (78% vs. 11%), with mean (SD) serum bicarbonate values 9.6 (5.1) mmol/1. V. cholerae was isolated from 25 (12%), Shigella spp. from 8 (3%), and Salmonella spp. from 3 (1%) of the patients who had rectal swab cultures. Mean (SD) hospital stay was 3.6 (2.1) days, during which the majority (80%) recovered fully, but 29 (13%) left earlier. Eleven (4%) of the neonates had to be referred elsewhere for treatment of other problems and 7 (3%) died. None of the neonates were exclusively breastfed on admission. Excluding mothers of adopted neonates, breastfeeding counseling enabled 64% of the mothers to convert to exclusive breastfeeding during the hospital stay. CONCLUSIONS: Most of the neonates admitted with diarrhea were small and underweight, and had poor feeding practices. The majority of neonates recovered soon, and were exclusively breastfeeding when discharged from the hospital. Breastfeeding counseling should be included as an integral part of case management at all health facilities.

Bangladesh↗